Acute unexplained T1-T2 fracture-dislocation following posterior instrumentation and fusion for paralytic scoliosis.

INTRODUCTION AND

IMPORTANCE

Upper thoracic fracture-dislocation following posterior instrumentation and fusion is rare, with potentially devastating neurologic consequences. The recommended treatment is an open reduction, spinal cord decompression, and a proximal extension of spinal instrumentation. To report the diagnosis and management of an acute non-traumatic T1-T2 fracture-dislocation, occurring in the early postoperative course of a posterior instrumentation and fusion for neurogenic scoliosis.

CASE REPORT: A 12-year-old spastic quadriplegic cerebral palsy (CP) male patient, who underwent an uneventful T2-S1 instrumentation for scoliosis, presented to the emergency department (ED) 2 weeks later, with mild fever, urinary retention, fecaloma and hypotonia of the 4 limbs, of few days duration. His parents reported no history of trauma and denied epileptic seizures. Atypical cervicothoracic spastic movements the night preceding his symptoms were the only relevant events of the patient's history. CT and MRI were both suggestive of a complete T1-T2 fracture-dislocation and spinal cord compromise.

CLINICAL DISCUSSION: The patient underwent immediate posterior decompression with wide lamino-arthrectomy, open reduction and proximal extension of his posterior instrumentation to C5. One year following surgery, there was only mild sensorimotor and bladder and bowel function recovery.

CONCLUSION

To our knowledge, this is the first report of an acute non-traumatic unexplained T1-T2 fracture-dislocation following posterior instrumentation and fusion. Despite a proper management, only very mild recovery was observed one year following surgery.